The purpose of this study is to examine how and why rural African American (AA) males decide to be screened for prostate cancer, with a specific focus on the role that the social networks of these men - their "health care advocates" - play in that decision. Rural AAs have been identified as both the most underserved and the most understudied population in the United States 3, 4 .No other studies have examined this critical element of AA men's cancer-related decision making processes. This exploratory study has three primary aims: Aim 1 is to explore who fills the role of "health care advocate" for rural AA men, how these individuals enact this role and what influence they have related to prostate cancer screening knowledge and decision-making of rural-dwelling AA men. Aim 2 is to explore how rural AA men perceive their communications with health care providers regarding prostate cancer screening. Aim 3 is to identify decisions made and explore the factors (health literacy, prostate cancer knowledge, decisional conflict and desire for control over health decisions) that influence prostate cancer screening decisions made among rural AA men. We will conduct a sequential mixed- method study starting with a baseline evaluation using qualitative interviews and a grounded theory approach along with quantitative surveys of both rural AA men and their health care advocate(s). Demographic data will be obtained and health literacy will be measured using the Shortened Test of Functional Health Literacy in Adults. Concurrent semi-structured interviews with the male participant and health care advocate(s) will uncover patterns, themes, and be used to generate a theory about how rural AA men make prostate cancer screening decisions. Moreover, their perceptions, as well as the advocate's perceptions, of the influence of advocates on those decisions will be discovered. We will compare and contrast these perceptions, and link them with quantitative survey data. Selection of measures for the quantitative surveys was based on Briss et al.'s (2004) informed decision model. Measures will include prostate cancer knowledge, decisional conflict and desire for control over health decisions. The second stage will include a 6 and 12 month follow-up telephone survey with the male participant. Using quantitative questions, we will assess whether the male participant chose/did not choose prostate cancer screening, and whether he experienced changes in prostate cancer knowledge, decisional conflict or desire for control over health decisions. We also will compare and or confirm the qualitative findings with follow-up open ended questions developed and added from the analysis of the qualitative findings at baseline. This research is consistent with the National Cancer Institute Strategic Objective 8: Overcome Cancer Health Disparities3. The study is significant in that rural AA men are a remarkably understudied group at great risk for health disparities. Pending the results of this project, the investigative team plans a larger and more expansive study including health care providers'perspectives (e.g. R01 application). 1 PUBLIC HEALTH RELEVANCE: Prostate cancer deaths among African American (AA) men in the United States are 2.4 times higher than among Caucasian men 1. Additionally, rural African Americans have been identified as both the most underserved and the most understudied population in the United States 3, 4. The primary purpose of this study is to provide in-depth information about factors that influence rural African American males'decision to undergo screening for prostate cancer, with a specific focus on the role that the social networks of these men - their "health care advocates" - play in that decision. No other studies have examined this critical element of rural AA men's cancer- related decision making processes.